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The Intensive Care Unit (ICU) is a unit in the hospital where seriously ill patients are cared by expert trained staff. In this unit, seriously ill patients require close observation and monitoring.

ICU is equipped with the most advanced medical equipment and ICU doctors and nurses are specially trained critical care staffs. Patients in the ICU are connected to machines to monitor their heart, blood pressure, and respiratory.

Note: The purpose of the ICU is to monitor the patients closely and continuously by the trained staff. The following cares can be mentioned: continues control of vital signs such as blood pressure, breathing and heart rate, review all medical tests, determine the patient’s level of consciousness, control and adjustment devices connected to the patient (such as ventilators, medical injection pumps and etc.

۲- Whichpatientsneedspecial care?

The following patients are required to admit to the ICU:

The patients who need vital signs control such as respiration, heart rate, blood pressure control and etc.

Also, patients may have a serious infection in their bodies that require specialized ICU care. The patients need close monitoring immediately after a major surgical operation or serious head injury.

The Patients may have heart and blood vessel problems (for example, very low or very high blood pressure, a heart attack, or an unstable heart rhythm).

The patients may have problems with their lungs that require ventilator support with breathing.

Patients in the ICU may have an imbalance in the level of chemicals, salts, or minerals in their bloodstream that require close monitoring as these levels are corrected.

The patients may have a serious infection in their bodies that require specialized ICU care.

The patients who areold people that require vital signs control due to exacerbation ofthe underlying disease.

۳- Who is the responsible for the patient in the ICU?

In the ICU, depending on the type of disease, different specialist such as surgeon, internist, cardiologist, infectious disease specialist collaborate together as a team.

۴- Why are the visiting hours so limited in the ICU?

It may seem the guidelines in the ICU are so strict; you must pay attention that you have to respect the rules because of accelerating the disease process and also preventing the potential infection.

Note that:

Avoid asking to visit the patients out of visiting hours. This may disturb the medical team when they are busy for treatment process.

Limit to call ICU. It is better that one of family member of the patients asks the doctor’s patient about the patient’s condition and inform the other family member.

۵- What is the artificial airway?

Some patients may have serious problems with their airway that they are not able to breathe on their own. Therefore they require breathing artificially. For this purpose, the specialist team put an oral or a nasal endotracheal tube (ETT). ETT is connected to a ventilator (breathing machines).

How to put endotracheal tube (ETT) into the patient’s airway

۶- What is the mechanical ventilator?

A “ventilator” is a machine that helps a patient breathe by giving oxygen through an ETT. Some patients may have serious problems with their lungs that require ventilator support with breathing. Ventilators (breathing machines) assist some patients with breathing until they are able to breathe on their own.

Patient can breathe by ETT and the connected tubes of the ventilator.

Note: ICU nurses are expert in ventilator’s setting and can change options of the device according to doctor’s order.

Important notes:

Never move or take out the oral or nasal tubes.

Never touch ventilator’s setting.

۷- What is the monitor on top of the patient’s bed?

The monitor top of the patient’s bed is connected to patients by some wires and shows patient’s heart, blood pressure, respiratory and temperature rate. ICU team can check vital signs of patients continuously using the monitors and the alarms of this device.

There is a monitor on the top of the patient’s bed in the ICU.

۸- What are the visiting conditions for the ICU?

Try to visit your patient at the proper time when the nurses allow you. You have to follow the bottom guidelines:

۱- Wash your hands before entering and after leaving the ICU.

۲- Avoid asking to visit the patients out of visiting hours.

۳- Limit the visiting of the patients because of safe health for you and patients.

۴- Say relaxing and promising words to your patient and be aware he/she can hear your voice because the hearing is the last sense to go.

۵- Wear Gown, mask and overshoe before entering the ICU.

Wear Gown, mask and overshoe before entering the ICU.

۶- Never touch the connected tubes to the patients and don’t move the connected devices.

۷- Patients may move the connected tubes because of the low level of consciousness. That is why the patient’s hands may be closed by roll bandage.

۸- Avoid asking to visit patients by two or more people simultaneously.

۹- Don’t carry your personal things to the ICU.

۱۰- You can give some favorite music of your patient and audio devices to ICU nurse that the patient listens to the music. This way can reduce the anxiety of ICU such as the sound’s alarm of the devices or the permanent ICU lights. This way can also raise the level of consciousness in some cases.

9- What is the intensive care for the patients in the ICU?

Patients are cared by trained staff especially in the ICU and the family members of the patient don’t require to be present with their patients.

Some intensive cares are in the following:

· The most of ICU patient are unable to eat on their own. Therefore a feeding oral -stomach or nasal stomach tube can supply the nutritional requirements of the patient.

Nutritional tube direction

Note:

۱- Nutrition: Sometimes patients cannot be fed by the tube, therefore venous feeding can help these cases. In some cases a tube is put in gastric track of the patient by surgery.

۲- Sanitary cares: The all sanitary cares such as daily bath in the ICU bed, teeth brushing and bedsheet changing are done for the patients by ICU staff.

۳- Eye health: If the patient is not able to blink, the eye does not reach the necessary moisture and may cause serious damage or eye infection. Therefore the patient’s eye is washed with serum sterile several times a day, and then close.

۴- Checking of vital signs: The vital signs of the patients such as respiration, heart rate and blood pressure are controlled and also recorded by the devices connected to the patients. The amount of food, serum, drug, urine, type of fluids, wound, skin color, Skin quality, size and movements of the pupil, response to environmental Stimulants, power of muscle, joint circulation and …… are checked carefully and recorded. The total check will be reported several times per day, even if the patient had no change in them. These reports help doctors make a proper treatment plan.

۵- Move the patient: if the consciousness level of the patient is low that he/she is unable to move in bed, during the day, every two hours, the patients are placed in various positions due to prevent bed sores.

۶- Respiratory care: respiratory care includes continuous and accurate monitoring of the respiratory system, use of oxygen in different ways (such as masks, canola), use of mechanical ventilation, chest physiotherapy, suction (evacuation of airway secretions with suction devices) and etc.

۷- Laboratorial tests: according to patient’s condition and doctor’s order, daily, the different samples such as blood, urine, wound fluid, cerebrospinal fluid or excrement are sent to laboratory.

۸- Physiotherapy: Due to prevention of organ failure, during a day, a physiotherapist visits the patients and does the necessary physiotherapy exercises. Chest physiotherapy is one of the most important exercises that can send out fluids from air way of the patients.

۹- Injection of multiple drugs: some patients need to get several drugs simultaneously and permanently. Therefore multiple infusion pumps are connected to the patients.

۱۰- When are patients transferred out of the ICU?

Sometimes the patients should be transferred from ICU to other units of hospital for some diagnostic actions such as sonography, CT scan, MRI and etc. A group of specialist including doctors, nurses and other personals moved the patients and all necessary equipment such as movable artificial respiration, heart monitor and bags for cardiopulmonary resuscitation are with the patients.

Doctors let the patients to transfer to other units only when he is confident about patients’ condition or in emergency situation that in these cases, all necessary equipment are moved with patients. The patients’ families must be relaxed and can visit their patients when they are transferred to other units and also the families can help the specialist team for transfer the patients.

Sometimes the patients should be transferred to other hospital. In these cases all necessary equipment are moved with the patients and also the specialist team go along with the patients till the patients arrive to the destinations.

۱۱- When are patients moved from ICU to general ward?

After the patients passed the acute conditions, with permission of the physician and specialist, they are transferred to general ward. The care and treatment will be continued in general ward.

In many cases the relatives of the patients prevent from transfer to general ward. But it must be said that, in fact, this transfer is part of the treatment process. It should be note that the long staying in ICU also has special side effects.

Some of these effects are as follows:

In some cases, when the patient’s consciousness level rises, because the patients have difficult conditions in ICU, they need to be near their families. In ICU, the patients can visit their families only in visiting hours but it is better that the patients transfer to general ward and be treated near their families. In most cases observed the patient’s level of consciousness significantly rises associated with beside their families.

Another effect of the ICU is depression. Patients because of the disaster are emotionally sensitive and vulnerable, and when they get consciousness partly, find themselves among a lot of facilities. Patients’ families can significantly calm down their patients psychologically with continuous presence.

Stress caused by noise and alarm of ICU devices are another side effect of ICU. Due to certain conditions, ICU is equipped with lots of equipment. Each of these devices is equipped with special alert and sirens for informing the nurse about critical patient’s condition. These environmental conditions cause stress for the patients.

Another side effect of long staying of patients in ICU is likely transmission of hospital infection to the patients. These microorganisms resist to common antibiotic because of its certain conditions. The infected patients with these infections will be hardly treated because their immune systems are weak.

Therefore due to the side effects of long staying in ICU, when doctor allows the patient to transfer to general ward, patients’ families have to collaborate with ICU team and must be sure that this transfer raises the level of patient’s consciousness and also prevents of side effects such as depression, ICU stress and hospital infections.

۱۲- What can be expected from a family member of a patient in the ICU?

Patients’ families must be relaxed and patient and try to collaborate with ICU team. As much as possible during the day only one family member contacts with ICU and receives information from nurses and doctors and share with other family members.

It must be prevented to call ICU or visit patients repeatedly because the patients require special arranged care and repeated visit or call may disturb treatment process. The patient’s visitors must take care of their nutrition and health because they should have enough energy to calm and care the patients.

It is better that the family members meet their patient turn and one by one, it means only one member come to hospital for visit the patient and the other members rest at home and in next visiting hours they replace and the other one come to hospital. It causes that the members have enough energy to care the patient. If the all members come to hospital with together, they disturb ICU team and make delay in treatment process.

۱۳- What can be expected from a family member of a patient in general ward?

When the patient is transferred to general world, the responsibility of family members will be started for care the patient. Each member should try to meet and care the patient 2-3 hours a day and say relaxing and promising words to the patient, he/she can hear the voice because the hearing is the last sense to go. The visitors must try to use sweet memories and things that the patient likes. If the patient’s level of consciousness is so that he/she can watch photos and videos, showing the images of the good old memories and playing of the film or his/her favorite songs can greatly improve the level of consciousness and help the patient’s relaxation.

Unfortunately, sometimes despite all the treatment facilities and ICU team efforts, the patient cannot be improved. Understanding this fact will be very difficult for family members of the patient. In this situation the family members should try to relax and ask necessary detailed information from the ICU team.